Prevalence and Clinical Characteristics of Refractory Hypertension

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> We aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives ( <jats:styled-content style="fixed-case">RH</jats:styled-content> ). Secondly, we assessed the prevalence of white‐coat RfH and clinical differences between true‐ and white‐coat RfH patients. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> The present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. <jats:styled-content style="fixed-case">RH</jats:styled-content> and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 ( <jats:styled-content style="fixed-case">RH</jats:styled-content> ) and 5 (RfH) antihypertensive drugs. White‐coat RfH was defined by RfH with normal (<130/80 mm Hg) 24‐hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of <jats:styled-content style="fixed-case">RH</jats:styled-content> , and 955 (1.4%) were considered as having RfH. Compared with <jats:styled-content style="fixed-case">RH</jats:styled-content> patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white‐coat <jats:styled-content style="fixed-case">RH</jats:styled-content> (26.7% versus 37.1%, <jats:italic>P</jats:italic> <0.001). White‐coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; <jats:italic>P</jats:italic> =0.018) and microalbuminuria (28.3% versus 42.9%; <jats:italic>P</jats:italic> =0.047). </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> The prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with <jats:styled-content style="fixed-case">RH</jats:styled-content> . One out of 4 patients with RfH have normal 24‐hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult‐to‐treat patients. </jats:p> </jats:sec>